It is estimated that nearly 1.23 lakh patients develop end-stage renal disease or chronic kidney disease (CKD) every year in India. However, 93 per cent of them never see a nephrologist because of lack of healthcare resources and affordability.
In its early stages, CKD can go undiagnosed because kidney diseases develop slowly. The symptoms only appear at a late stage when the patient has developed kidney failure and requires dialysis, explains G.K. Venkatesh, director of the Institute of Nephro-Urology in Bangalore.
So, doctors say, a significant percentage of the people affected require renal replacement therapy such as dialysis or kidney transplant — the only available treatment options.
Dialysis or transplant?
In fact, says Gokulnath, professor and Head of Nephrology at St. John’s Hospital in the State capital, life is not sustainable without dialysis or transplants.
Although people can survive for nearly 15 to 20 years on dialysis (if they develop the problem before they are 40), the quality of life after transplant is much better, he says.
“Of the 5,664 kidney transplants done in India in 2012, 350 were in Karnataka. Nearly 36,000 patients are on dialysis every month in the country, of which around 3,750 are from the State,” Dr. Gokulnath adds.
A costly affair
A patient undergoing dialysis may need at least three sessions a week.
The costs for each session range between Rs. 1,000 and Rs. 2,000 in a private hospital.
The State-run Institute of Nephro-Urology, which has centres in 28 districts, K.C. General, Jayanagar General and Bowring and Lady Curzon Hospitals in Bangalore are among those that provide dialysis at highly subsidised costs (from between Rs. 250 to Rs. 500), but doctors there say it is not possible for government hospitals to provide maintenance dialysis to the same set of patients, as new patients turn up every month.
Treatment at home
Dr. Gokulnath says people have two options when it comes to dialysis — haemodialysis and continuous ambulatory peritoneal dialysis (CAPD).
While a patient has to visit the hospital at least thrice a week for haemodialysis, CAPD can be done at home. This also helps the patient save on commuting and medication.
There are 6,500 people in the country on CAPD and of them, 300 are from Karnataka, he says.
According to nephrologists, at least 60 per cent of people develop kidney problems because of other diseases such as diabetes and hypertension. And, renal dysfunction can in turn trigger cardiovascular diseases.
Dr. Gokulnath says basic health screening tests including urine and blood tests, and ultrasound, are important in preventing CKD.
Early diagnosis can significantly delay or even prevent kidney failure and the subsequent need for dialysis.
Healthy lifestyle choices also play a crucial role in renal health. If a kidney disease is identified early, it can often be managed through diet, medication and lifestyle adjustments, the doctors add.